Provider Demographics
NPI:1962630475
Name:BELL, ALISSA LEIGH (APRN)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:LEIGH
Last Name:BELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ALISSA
Other - Middle Name:LEIGH
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 1390
Mailing Address - Street 2:
Mailing Address - City:CAMPTON
Mailing Address - State:KY
Mailing Address - Zip Code:41301-1390
Mailing Address - Country:US
Mailing Address - Phone:606-668-7385
Mailing Address - Fax:606-668-7009
Practice Address - Street 1:202 PLUMMER ST
Practice Address - Street 2:
Practice Address - City:CAMPTON
Practice Address - State:KY
Practice Address - Zip Code:41301-9381
Practice Address - Country:US
Practice Address - Phone:606-668-7385
Practice Address - Fax:606-668-7009
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006091363LF0000X
KY30066091363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100081560Medicaid
KY0952112OtherCGS MEDICARE PART B KENTUCKY